Checklist

WIPER

• Patient lying down, undressed from the waist down. Chaperone as required.

Physiological parameters

Inspection

• Hair distribution: measure of sexual development

• Rash/coloured areas: infection, atrophy

• Ulcers: see notes below for differential diagnosis

• Lumps: painful or painless

• Sinus openings: fistula

• Scars/asymmetry: previous surgery

Gently separate the labia.

• Inspect for all the above: do not forget to look at the medial aspect of the labia

• Size and shape of clitoris

• Urethra: urethral caruncle/prolapse

• Presence of discharge from urethral orifice and/or vaginal outlet

Ask the patient to bear down.

• Presence of lump/bulge: cystocoele/rectocoele/uterine prolapse

Ask the patient to cough.

• Leakage of urine: stress incontinence

Cusco's and Sims' speculum examination

• To visualise the vaginal walls and cervix

• To obtain specific samples (for cytology, microbiology)

Palpation/digital bimanual examination

• Lumps: Bartholin's cyst or abscess

• Vaginal walls

• Cervix: shape, consistency, regularity, mobility, tenderness

• Uterus: size, shape, consistency, position, mobility

• Adnexae: presence of any masses; if any determine characteristics

• Uterosacral ligaments in the pouch of Douglas: regularity, tenderness

To complete the examination…

• Examine the abdomen: remember, if an enlarged pelvic organ is palpable abdominally, you cannot get below it.

• Examine the groins: lymphadenopathy (if vulval pathology is present).

• Perform a rectal examination: identify pelvic masses/tenderness and distinguish between enterocoele and rectocoele.